Access to abortion is becoming increasingly difficult in the era of state-mandated Targeted Regulation of Abortion (TRAP) laws. Of particular concern is the so-called “heartbeat” law, wherein abortion is deemed illegal after visualization of fetal cardiac activity. These laws may prohibit abortion access as early as after six weeks gestation, effectively eliminating access to the safest abortion procedures. Previous research, summarized in the Society of Family Planning (SFP) Guideline #20132, has shown the safety of abortion very early in pregnancy, even in the absence of a visualized gestational sac; despite this safety, data suggest that fewer than 50% of providers are comfortable providing services in this age range. This same SFP guideline calls for research to understand and address the barriers to access to abortion early in pregnancy.

We propose a mixed method study of abortion providers in the greater Boston area. We will invite providers to complete an electronic survey about their early abortion practices. We will then conduct semi-structured interviews with a sample of providers who do and do not provide early abortion. The aim of this study is to understand the current practices, facilitators and barriers to early abortion services at a range of facilities. We will utilize an implementation science framework, which actively assists in translating evidence-based recommendations into clinical practice by identifying barriers and facilitators to widespread application of a recommendation and creating appropriate adaptations to improve uptake. Ultimately, our findings will be used to develop an implementation strategy to increase early abortion access.